Posts tagged car
Photo: Patients at the community hospital in Bangui, where MSF treated people wounded in conflict. CAR 2013 © Francois Beda/MSF
In Central African Republic, the Violence Has Ended But the Emergency Continues
“At the height of the crisis, confrontations, shootings, and abuses occurred daily. Today, tension and violence have subsided and we are now in a particularly delicate phase—a sort of false calm that is both fragile and potentially explosive. Seleka’s two main groups will have to begin negotiations to establish an imminent power-sharing arrangement. There could be friction and clashes within this young coalition,” says MSF head of mission in CAR, Serge St-Louis.
As a medical organization, we are very concerned about the unmet needs among a population that was already very vulnerable prior to the Seleka offensive. There are thousands of displaced persons who now live in extremely precarious conditions, without medical care, shelter, food, or water. The health situation is critical in several regions. There are serious shortages of drugs and supplies and there are no health care personnel in the medical facilities. Based on our latest admission figures, the seasonal epidemic of malaria, which is endemic in the CAR, appears to have begun and will surge in the rainy season.
Photo: Jordan, 14, injured during the fighting in Bangui, CAR. CAR 2013 © Francois Beda/MSF
In CAR, Situation Stabilizing but Tense
Jordan, 14, lives in the Miskine neighborhood of the eighth arrondissement in Bangui. His mother explains what happened to her son during the fighting.
“Jordan was with me at home when the rebels entered Bangui. They fired their rifles and Jordan was hit in the leg by a stray bullet. A pastor from our church took him to the hospital. We’ve been at the community hospital since Sunday. I saw that MSF was working in the hospital and helping the medical staff treat the wounded – there are lots of them. My son is doing better. I hope that he will recover quickly and that we’ll be able to go home very soon.”
We also notice the fear in the population—people are still afraid to go out, to leave their homes; and there is no public transport, so even if people do want to get back to work, it’s difficult for them to move around.
Photo: MSF doctor finds a way to bring a smile to her patient. CAR 2012 © Corentin Fohlen/Divergence
Photo: A sign prohibits firearms in an MSF facility in a town outside Bangui. CAR 2007 © Spencer Platt
Central African Republic: All Parties Must Allow Access to Health Care
Violence and insecurity in Bangui over the last 48 hours have seriously disrupted MSF’s operations and prevented critically wounded patients from being referred to surgical facilities. Displaced people throughout the country and in major cities taken by Seleka are also too fearful to access health facilities. MSF facilities in Bangui and Batangafo have been looted and robbed.
“MSF condemns the looting and robberies of our facilities and reminds all parties that medical personnel must be respected and protected and must be granted all available help in the performance of their duties,” said Serge St. Louis, MSF head of mission in Bangui.
All parties to the conflict must respect medical structures, ambulances, medical personnel, and sick and wounded patients, and guarantee access to health facilities without the risk of being targeted, MSF said.
Photo: Patients wait for triage at the Damara Health Center in the Central African Republic.CAR 2013 © Chloé Cébron/MSF
MSF Expands Emergency Services in CAR While Waiting For Peace Deal To Take Hold
As the government of Central African Republic (CAR) attempts to implement a peace deal it struck with rebel groups in the country, Doctors Without Borders/Médecins Sans Frontières (MSF) is continuing to expand its emergency response to thousands of people who have been affected by the conflict. MSF is also negotiating for greater access to areas where health care staff has fled and basic medical services are no longer available.
In recent weeks, as the conflict worsened, thousands of civilians fled their homes and sought refuge in the bush, where they tried to subsist without proper shelter, safe drinking water, or access to medical services. On January 10, MSF opened an emergency project in the government-held frontline town of Damara and began providing basic health care, conducting mobile clinics, and supporting displaced people in order to prevent deaths due to common illnesses such as diarrhea, respiratory infections, and malaria, which is a chronic health care threat in CAR. Medical staff has been treating up to 100 patients per day, most of them for malaria and malnutrition.
“The Central African population already suffers from some of the worst health indicators in the world, with alarming mortality rates even in peaceful times,” says Sylvain Groulx, an MSF coordinator in CAR. “Because of the recent instability, many people have been forced to displace themselves. An added burden is the fact that many local health facilities closed when medical staff fled into the bush. The few health posts that have remained open are either running out of basic essential medicines or, worse, had their stock completely looted.”
Photo: Young mothers and their newborns at the Maternity service of the MSF-supported hospital in Batangafo. CAR 2012 © Chloé Cébron
As Violence Surges Anew in CAR, Families Again Flee Into The Bush
On December 20, the rebel coalition known as “Seleka, which has attacked several locations in the north of Central African Republic (CAR) in recent days, entered the town of Batangafo, where Doctors Without Borders/Médecins Sans Frontières (MSF) has been supporting the main hospital.
The previous day, after the rebels announced their intention to move towards Bouca, through the town of Batangafo, FACA—the Central African military forces—the gendarmerie, and all public authorities fled the town. Numerous civilians, scared by the threat of an attack, also left Batangafo to seek refuge into the bush. The rebels entered and took the town 24 hours later.
MSF maintains its team on the ground and is continuing its activities at the hospital, though the number of consultations dropped from 193 the day before the rebels’ advances to 38 on the day after they entered the town.
Testimonies collected by MSF’s team in Batangafo a few hours before rebels entered the town illustrate the fear pervasive among a population that has already endured more than 10 years of armed conflicts. Fleeing into the bush has become almost routine at this point, though it certainly hasn’t gotten any easier or less fraught. “I am very worried by the situation, said a 55-year-old woman named Ghislaine. “Yesterday the kids at school fled in the bush when they heard that armed troops were arriving in town. We did not know where they were. We are so scared.”
According to Enoch Nodl-ya, an MSF anesthetist nurse at Batangafo hospital, “for the last ten years the population has endured the regular presence and attacks from armed men in this region. People are scared and flee rapidly into the bush. As a consequence, many women give birth in the fields without any assistance and most sick or wounded are hesitant to receive medical assistance, scared of possible violence in the populated areas. When the violence stops, we often see patients coming in an advance stage of their diseases.”
Our patient from the other day first presented to an outside clinic, where there is no surgeon, when he still felt too weak to stand several days after being beaten with fists and sticks. He was admitted to the clinic with a swollen, distended abdomen and increasing pain, given intravenous fluids, evaluated with an X-ray and a blood count, suggesting blood loss, followed by a phone call to our project chief and a discussion with me about transfer. At home this patient would have had a CT scan to identify whether he had an injury to the spleen and/or liver, plus checked for signs of other injuries that would suggest he needed surgery. With a stable liver or spleen injury, he would be placed at bed rest to minimize the chance of recurrent bleeding. Here in the Central African Republic the choice was to risk leaving him at a facility that had no capability for an operation or transfer him to Paoua by LandRover with the risk of making any potential bleeding worse, as the trip is slightly less jarring than playing a game of rugby. We told them to send him over as soon as they could. Due to a combination of vehicle availability, road conditions and security issues, it was a full 24 hours before he arrived in Paoua, now almost six days from his initial injury.
I love surgery. I am grateful to be a surgeon. But I have always thought of it as something that I do for work, not who I am. However in Paoua, I am nothing more than the surgeon. It is who I am, what I do.
When the hospital radios the residential compound after hours, the call is for “le chirurgien,” not for me by name. MSF brought me here to be their surgeon. Their expectation was that I could practice broadly in my own field plus was willing and able to practice outside the realm of general surgery including performing c-sections. I am also asked to provide care for problems that back home would be handled by other specialists; orthopedic surgeons, ENT doctors, urologists and dentists to name a few.
In the US, I never practice outside the field of my expertise. Although my training covered a broad range of surgical specialties, I have pursued a sub-specialty practice over the years. In the US, if I see a patient with a problem that can be better addressed by another specialist with different training or experience, I refer the patient. In Paoua, I have no referral options. There are no other surgical specialists in Paoua and only a limited number in Bangui. Most people I see here have severely limited resources and are no more able to seek a consultation in the capital as to take a trip to the Mayo Clinic. If we can’t help them in Paoua, they don’t get help anywhere else.
In his latest blog post, US surgeon David Lauter describes having to decide whether or not to treat an infant girl for a gynecological condition outside his area of expertise. David is working in MSF’s hospital in Paoua, Central African Republic. Please leave your questions and comments for David in the comments box below his blog post.
What strikes me the most about my accommodation is that compared to how the average person in Paoua lives, my residential compound is like staying at a five star luxury hotel in New York or Paris. As far as I can tell, no one in Paoua has electricity in their home.
When I examined Francoise, she was skinny even by local standards, with arms and legs like sticks, and thin sticks at that. She stood up and her belly protruded like a pregnant woman’s. The mass was in her mid left torso. I could feel its texture through her tense skin and thinned abdominal wall; it was hard as a rock, rough and knobby in texture. It felt like a cancer.
The End of a Brave Fight
It is with great sadness we report the death of Giblotte Nodjindo.
After a long and brave fight against multidrug-resistant tuberculosis, Giblotte sadly succumbed to her illness in July this year. Giblotte was an integral part of MSF’s TB&ME project, a blog which gives a voice to our TB patients. Read her final post.
The local people are so poor and have so little, but the common humanity is obvious; mothers stand canted to one side with their one-year-olds on their hips, brothers and sisters play and fight, men and women laugh at jokes, cry at sadness, all like at home.
As he settles in to life in Paoua with MSF, David begins to reflect on the parallels and differences between life in the Central African Republic and back home in Bellevue, Washington.
Please leave your questions and comments for David in the comments box below his blog post.
Photo: A child recovering from malaria receives treatment at the MSF hospital in Boguila. © Andrew Green
The Central African Republic’s silent health crisis
“When I was coming for the first time to CAR, I became really disappointed. It was the first time I saw in a poor country so many health concerns,” said Nicolas Yves Pierre Alexandre, a medical advocacy coordinator for MSF.
The Central African Republic has the second-lowest life expectancy in the world. This article from The Lancet explores why the situation is the way it is, with quotes from MSF staff working in the country.
Sleeping Sickness: Treating a Neglected Disease in Central African Republic
Sleeping sickness, which is transmitted by the tsetse fly, is mainly found in central Africa. During the first stage of the illness, people feel feverish and weak, but once the parasite enters their central nervous system, their symptoms change, and they become confused, lose their coordination, and suffer sleep disturbances and personality changes. Their mental faculties deteriorate until eventually they sink into a coma—the long sleep which gives the illness its name.
Since 2006, monitoring and controlling sleeping sickness in the remote and inaccessible southeast of CAR has been particularly difficult due to cross-border attacks by the Ugandan rebel group known as the Lord’s Resistance Army.
This past July, MSF’s mobile sleeping sickness team spent 18 days screening and treating people for the disease in Mboki, in CAR’s Haut M’boumou region. In the week before screening started, community health workers, with the help of local authorities, traveled around the area raising awareness of the disease and passing on the message that free testing and treatment were available.
Photo: An MSF health worker checks a young boy for signs of sleeping sickness in Mboki, Central African Republic.
CAR 2012 © Sebastian Bolesch
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Doctors Without Borders/ Médecins Sans Frontières (MSF) is an international medical humanitarian organization working in more than 60 countries to assist people whose survival is threatened by violence, neglect, or catastrophe. You can also find us on Twitter and Facebook.
